The University of Southampton
University of Southampton Institutional Repository

Permutations of time and place in tuberculosis

Permutations of time and place in tuberculosis
Permutations of time and place in tuberculosis
Tuberculosis remains a global health pandemic. The current depiction of the Mycobacterium tuberculosis life cycle proposes that airborne bacilli are inhaled and phagocytosed by alveolar macrophages, resulting in the formation of a granuloma that ruptures into the airways to reinitiate the infectious cycle. However, this widely proposed model overlooks the fact, established 100 years ago, that the initial site of M tuberculosis implantation is in the lower zones of the lungs, whereas infectious cavitary pulmonary disease develops at the lung apices. The immunological events at these two pulmonary locations are different—cavitation only occurs in the apices and not in the bases. Yet the current conceptual model of tuberculosis renders the immunology of these two temporally and spatially separated events identical. One key consequence is that prevention of primary childhood tuberculosis at the lung bases is regarded as adequate immunological protection, but extensive evidence shows that greater immunity could predispose to immunopathology and transmission at the lung apex. A much greater understanding of time and place in the immunopathological mechanisms underlying human tuberculosis is needed before further pre-exposure vaccination trials can be done
1473-3099
1357-1360
Elkington, P.T.
60828c7c-3d32-47c9-9fcc-6c4c54c35a15
Friedland, J.S.
e64a7af8-b969-4426-82e6-5ebe819799c9
Elkington, P.T.
60828c7c-3d32-47c9-9fcc-6c4c54c35a15
Friedland, J.S.
e64a7af8-b969-4426-82e6-5ebe819799c9

Elkington, P.T. and Friedland, J.S. (2015) Permutations of time and place in tuberculosis. The Lancet Infectious Diseases, 15 (11), 1357-1360. (doi:10.1016/S1473-3099(15)00135-8). (PMID:26321650)

Record type: Article

Abstract

Tuberculosis remains a global health pandemic. The current depiction of the Mycobacterium tuberculosis life cycle proposes that airborne bacilli are inhaled and phagocytosed by alveolar macrophages, resulting in the formation of a granuloma that ruptures into the airways to reinitiate the infectious cycle. However, this widely proposed model overlooks the fact, established 100 years ago, that the initial site of M tuberculosis implantation is in the lower zones of the lungs, whereas infectious cavitary pulmonary disease develops at the lung apices. The immunological events at these two pulmonary locations are different—cavitation only occurs in the apices and not in the bases. Yet the current conceptual model of tuberculosis renders the immunology of these two temporally and spatially separated events identical. One key consequence is that prevention of primary childhood tuberculosis at the lung bases is regarded as adequate immunological protection, but extensive evidence shows that greater immunity could predispose to immunopathology and transmission at the lung apex. A much greater understanding of time and place in the immunopathological mechanisms underlying human tuberculosis is needed before further pre-exposure vaccination trials can be done

Text
__userfiles.soton.ac.uk_Users_spd_mydesktop_Elkington_LID_accepted.pdf - Accepted Manuscript
Download (564kB)

More information

e-pub ahead of print date: 28 August 2015
Published date: November 2015
Organisations: Clinical & Experimental Sciences

Identifiers

Local EPrints ID: 381234
URI: https://eprints.soton.ac.uk/id/eprint/381234
ISSN: 1473-3099
PURE UUID: c9cfb664-b580-4218-91d8-2a052e6e144e
ORCID for P.T. Elkington: ORCID iD orcid.org/0000-0003-0390-0613

Catalogue record

Date deposited: 01 Oct 2015 09:07
Last modified: 06 Jun 2018 12:28

Export record

Altmetrics

Contributors

Author: P.T. Elkington ORCID iD
Author: J.S. Friedland

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of https://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×